4 - Male Urology Flashcards
What is phimosis?
- Foreskin cannot be fully retracted from around the tip of the penis
- Normal to be non-retractable in adolescence, e.g 50% cannot be retracted at 1 year
What can be the consequences of phimosis?
- Poor hygeine so more STDs
- Pain
What is Balantis Xerotica Obliterans?
- Lichen sclerosus of the male genitalia
- A chronic, often progressive disease, which can lead to phimosis and urethral stenosis
What is paraphimosis and what are the most commonest causes?
- Foreskin can no longer be pulled forward over the tip of the penis causing the foreskin to become swollen and stuck
- Phimosis, Catheterisation (esp the elderly) and Penile Cancer are all causes
How do you treat phimosis and paraphimosis?
- Circumsion for phimosis (be careful if have phimosis and balantis, may have underlying cancer)
- Needs reduction manually or dorsal slit may be necessary
What type of cancer is penile cancer and what are the risk factors?
- Squamous cell carcinoma
- Really rare
- Phimosis, hygeine and smegma are risk factors
- HPV 16 and 18 are risk factors
- Untreated most die in two years
Why may a male have a circumsion?
What are some of the causes of acute scrotal pain?
- Testicular torsion
- Epididymitis/Orchitis/Epididymoorchitis
- Torsion of hyatid of Morgagni
- Trauma
- Ureteric calculi (referred pain, often blood in urine)
What can epididymitis be caused by?
- UTIs
- STIs
- Mumps
How would testicular torsion present?
- Younger patient
- Sudden onset e.g wake to pain
- Unilateral pain
- May be vomiting and no LUTS
- Tender testes that lie high and horizontal in scrotum
EMERGENCY SCROTAL EXPLORATION - don’t waste time with tests
What would you see in the history and examination of a male with epididymo-orchitis?
- Gradual unilateral onset
- Recent history of UTI, unprotected sex, mumps, catheter
- Age 20-40 STI (Chlaymdia) and 40/50 often UTI (E.Coli)
- Pyrexial
- Red enlarged tender testis or epididymis
- May have reactive hydrocoele or fluctuant areas showing an abscess
- Fournier’s Gangrene (high mortalitiy)
What is Fournier’s gangrene?
Type of necrotizing fasciitis affecting the external genitalia as a complication of epididymitis, more common in poorly controlled diabetes
How do you investigate suspected epididymoorchitis and treat it?
- Blood cultures and FBCs
- Mid stream urine sample
- Scrotal ultrasound if suspected abscess
What are some questions you need to ask when a male presents with a scrotal lump?
- Is it painful?
- How quickly has it occured?
- Can I get above it? If yes it is scrotal in origin
- Is it in the body of the testes? If yes it could be a tumour
- Is it separate to the testis?
- Does it fluctuate and transilluminate?
What are some common causes of scrotal lumps?
Painless:
- Testis tumour
- Epididymal cyst
- Hydrocoele
- Reducible inguino-scrotal hernia
- Varicocoele (aching at end of day)
Painful:
- Epididymitis
- Epididymo-orchitis
- Stranfulated inguino-scrotal hernia